Provider Demographics
NPI:1174839476
Name:KIRTANE ASSOCIATES M.D., P.A.
Entity Type:Organization
Organization Name:KIRTANE ASSOCIATES M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRISH
Authorized Official - Middle Name:KAMALAKAR
Authorized Official - Last Name:KIRTANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-788-7844
Mailing Address - Street 1:PO BOX 160127
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-0127
Mailing Address - Country:US
Mailing Address - Phone:407-788-7844
Mailing Address - Fax:407-682-6071
Practice Address - Street 1:210 N WESTMONTE DR
Practice Address - Street 2:SUITE 1000
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3311
Practice Address - Country:US
Practice Address - Phone:407-788-7844
Practice Address - Fax:407-682-6071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37121207RG0100X
FLME38048207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME38048OtherLISCENSE
FL065694100Medicaid
FL065091900Medicaid
FLME37121OtherLISCENSE
FLD55032Medicare UPIN
FLD55046Medicare UPIN